User:Asollers/Obsessive–compulsive disorder

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Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general function. As indicated by the disorder's name, the primary symptoms of OCD are obsessions and compulsions. Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort. Common obsessions include fear of contamination, obsession with symmetry, and intrusive thoughts about religion, sex, and harm. Compulsions are repeated actions or routines that occur in response to obsessions. Common compulsions include excessive hand washing, cleaning, counting, ordering, hoarding, neutralizing, seeking reassurance, and checking things. Washing is in response to the fear of contamination. Ordering is the preference for tasks to be completed a specific way (e.g., organizing clothes a specific way). Hoarding is the collecting of unnecessary objects (e.g., collecting food wrappers). Neutralizing is the act of engaging in a ritual to make up for supposedly "bad behavior". Checking is the compulsion to check particular objects/places to ensure they are a certain way (e.g., checking to ensure the water is turned off). People with OCD tend to be overly cleanly, repeatedly count objects, and seek reassurance to avoid making a mistake. Many adults with OCD are aware that their compulsions do not make sense, but they perform them anyway to relieve the distress caused by obsessions. Compulsions occur so often, typically taking up at least one hour per day, that they impair one's quality of life.

Associated conditions[edit]

People with OCD may be diagnosed with other conditions as well, such as obsessive–compulsive personality disorder, major depressive disorder, bipolar disorder, generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, transformation obsession, ASD, ADHD, dermatillomania, body dysmorphic disorder, and trichotillomania. More than 50% of people with OCD experience suicidal tendencies, and 15% have attempted suicide. Depression, anxiety, and prior suicide attempts increase the risk of future suicide attempts.

It has been found that between 18-34% of females are currently experiencing or will experience OCD in their lifetime. Of that 18-34%, 7% are likely to have an eating disorder. Roughly 0-5% of males have OCD and an eating disorder.

Individuals with OCD have also been found to be affected by delayed sleep phase disorder at a substantially higher rate than the general public. Moreover, severe OCD symptoms are consistently associated with greater sleep disturbance. Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset.

Some research has demonstrated a link between drug addiction and OCD. For example, there is a higher risk of drug addiction among those with any anxiety disorder, likely as a way of coping with the heightened levels of anxiety. However, drug addiction among people with OCD may be a compulsive behavior. Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD, or any other anxiety disorder, may feel "out of control".

Someone exhibiting OCD signs does not necessarily have OCD. Behaviors that present as obsessive–compulsive can also be found in a number of other conditions, including obsessive–compulsive personality disorder (OCPD), autism spectrum disorder (ASD), or disorders in which perseveration is a possible feature (ADHD, PTSD, bodily disorders, or stereotyped behaviors).Some cases of OCD present symptoms typically associated with Tourette syndrome, such as compulsions that may appear to resemble motor tics; this has been termed tic-related OCD or Tourettic OCD.

OCD frequently occurs comorbidly with both bipolar disorder and major depressive disorder. Between 60 and 80% of those with OCD experience a major depressive episode in their lifetime. Comorbidity rates have been reported at between 19 and 90%, as a result of methodological differences. Between 9–35% of those with bipolar disorder also have OCD, compared to 1–2% in the general population. About 50% of those with OCD experience cyclothymic traits or hypomanic episodes. OCD is also associated with anxiety disorders. Lifetime comorbidity for OCD has been reported at 22% for specific phobia, 18% for social anxiety disorder, 12% for panic disorder, and 30% for generalized anxiety disorder. The comorbidity rate for OCD and ADHD has been reported to be as high as 51%.

Genetics[edit]

There appear to be some genetic components of OCD causation, with identical twins more often affected than fraternal twins. Furthermore, individuals with OCD are more likely to have first-degree family members exhibiting the same disorders than matched controls. In cases in which OCD develops during childhood, there is a much stronger familial link in the disorder than with cases in which OCD develops later in adulthood. In general, genetic factors account for 45–65% of the variability in OCD symptoms in children diagnosed with the disorder. A 2007 study found evidence supporting the possibility of a heritable risk for OCD.

Research has found there to be a genetic correlation between anorexia nervosa and OCD, suggesting a strong etiology. First and second hand relatives of probands with OCD have a greater risk of developing anorexia nervosa as genetic relatedness increases.

A mutation has been found in the human serotonin transporter gene hSERT in unrelated families with OCD.

A systematic review found that while neither allele was associated with OCD overall, in Caucasians, the L allele was associated with OCD.Another meta-analysis observed an increased risk in those with the homozygous S allele, but found the LS genotype to be inversely associated with OCD.

A genome-wide association study found OCD to be linked with single-nucleotide polymorphisms (SNPs) near BTBD3, and two SNPs in DLGAP1 in a trio-based analysis, but no SNP reached significance when analyzed with case-control data.

One meta-analysis found a small but significant association between a polymorphism in SLC1A1 and OCD.

The relationship between OCD and Catechol-O-methyltransferase (COMT) has been inconsistent, with one meta-analysis reporting a significant association, albeit only in men, and another meta analysis reporting no association.

It has been postulated by evolutionary psychologists that moderate versions of compulsive behavior may have had evolutionary advantages. Examples would be moderate constant checking of hygiene, the hearth, or the environment for enemies. Similarly, hoarding may have had evolutionary advantages. In this view, OCD may be the extreme statistical tail of such behaviors, possibly the result of a high number of predisposing genes.

Therapy[edit]

One exposure and ritual prevention activity would be to check the lock only once and then leave. The specific CBT technique used is called exposure and response prevention (ERP), which involves teaching the person to deliberately come into contact with situations that trigger obsessive thoughts and fears (exposure), without carrying out the usual compulsive acts associated with the obsession (response prevention). This technique causes patients to gradually learn to tolerate the discomfort and anxiety associated with not performing their compulsions. For many patients, ERP is the add-on treatment of choice when selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) medication does not effectively treat OCD symptoms, or vice versa, for individuals who begin treatment with psychotherapy.

For example, a patient might be asked to touch something very mildly contaminated (exposure), and wash their hands only once afterward (response prevention). Another example might entail asking the patient to leave the house and check the lock only once (exposure), without going back to check again (response prevention). After succeeding at one stage of treatment, the patient's level of discomfort in the exposure phase can be increased. When this therapy is successful, the patient will quickly habituate to an anxiety-producing situation, discovering a considerable drop in anxiety level.

ERP has a strong evidence base, and is considered the most effective treatment for OCD. However, this claim was doubted by some researchers in 2000, who criticized the quality of many studies.

Acceptance and commitment therapy (ACT), a newer therapy also used to treat anxiety and depression, has also been found to be effective in treatment of OCD. ACT uses acceptance and mindfulness strategies to teach patients not to overreact to or avoid unpleasant thoughts and feelings but rather "move toward valued behavior."

A 2007 Cochrane review found that psychological interventions derived from CBT models, such as ERP and ACT, were more effective than non-CBT interventions. Other forms of psychotherapy, such as psychodynamics and psychoanalysis, may help in managing some aspects of the disorder. However, in 2007, the American Psychiatric Association (APA) noted a lack of controlled studies showing their efficacy, "in dealing with the core symptoms of OCD." For body-focused repetitive behaviors (BFRB), behavioral interventions such as habit-reversal training and decoupling are recommended.

Psychotherapy in combination with psychiatric medication may be more effective than either option alone for individuals with severe OCD. ERP coupled with weight restoration and serotonin reputake inhibitors has proven the most effective when treating OCD and an eating disorder simultaneously.